Penatalaksanaan Hipertensi Emergensi

Abstract

Hipertensi emergensi didefinisikan sebagai tekanan darah sistolik >180 mmHg dan/atau tekanan darah diastolik >120 mmHg disertai bukti kerusakan organ target (target organ damage). Target penurunan tekanan darah pada hipertensi emergensi adalah segera dalam hitungan menit hingga 1-2 jam, sehingga diperlukan obat antihipertensi intravena dengan onset kerja cepat dan durasi kerja pendek (short acting). Prinsip pemilihan obat antihipertensi injeksi adalah berdasarkan presentasi klinis, obat pilihan pertama atau kedua, faktor komorbid, kontraindikasi, dan ketersediaan obat. Labetalol dan nicardipine adalah dua obat antihipertensi yang paling banyak direkomendasikan dalam berbagai guideline sebagai terapi lini pertama berbagai bentuk klinis hipertensi emergensi. Tujuan pengobatan hipertensi emergensi adalah mencegah atau membatasi kerusakan organ target lebih lanjut. Penurunan tekanan darah dilakukan secara gradual untuk mengembalikan autoregulasi organ, sehingga perfusi organ yang normal dapat dipertahankan.

Hypertensive emergency is defined as systolic blood pressure >180 mmHg and/or diastolic blood pressure >120 mmHg with evidence of target organ damage. The target of lowering blood pressure in hypertensive emergency is immediately within minutes to 1-2 hours, so intravenous antihypertensive drugs with a rapid onset of action and short acting duration are needed. The principle of drug selection is based on the clinical presentation with consideration of the target organ damage, the first or second drug of choice, comorbid factors, contraindications, and availability. Labetalol and nicardipine are the two most widely recommended antihypertensive drugs in various guidelines as first-line therapy in various forms of clinical presentation of hypertensive emergency. The goal of treatment is to prevent or limit further target organ damage. Blood pressure reduction is conducted gradually to restore organ autoregulation, to maintain normal organ perfusion